Provider Demographics
NPI:1588612105
Name:KRAVITZ, JOHN JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAY
Last Name:KRAVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15000 MIDLANTIC DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1573
Mailing Address - Country:US
Mailing Address - Phone:856-996-4001
Mailing Address - Fax:856-996-4007
Practice Address - Street 1:15000 MIDLANTIC DR
Practice Address - Street 2:SUITE 110
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1573
Practice Address - Country:US
Practice Address - Phone:856-996-4001
Practice Address - Fax:856-996-4007
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03264500207RG0100X
PAMD014473E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1659328698OtherGROUP NPI #
NJ1659328698OtherGROUP NPI #
C60756Medicare UPIN
PA1659328698OtherGROUP NPI #
NJ098695ANKMedicare ID - Type Unspecified